Sammanfattning
We report the case of 52-year-old male with homozygous alpha-1-antitrypsin deficiency (AATD), who developed hepatitis-like symptoms 33 days after the initiation of dalteparin treatment. The patient had no previous signs of liver dysfunction or drug reactions. During hospitalization due to acute dyspnea he developed symptomatic thrombophlebitis and was treated with dalteparinsodium. One month after initiation of therapy, he presented to the ER with jaundice and abnormal liver tests. Radiologic and endoscopic examination showed no signs of biliary obstruction. The only change in drug therapy during the past 6 months was the addition of dalteparin. A liver biopsy showed signs of a combined cholestatic and toxic hepatitis. The liver function tests declined rapidly following discontinuation of treatment and a second liver biopsy showed no remaining signs of hepatitis. Despite the full recovery, it cannot be excluded that the AATD or co-medication contributed to the cholestatic reaction.